We have about 700 species of microbes in our mouth. These include germs such as bacteria and fungi. Some of these microbes are helpful while others contribute to problems including tooth decay, gum disease and bad breath. The helpful germs keep the others in check. However, things you do may tip the scales allowing the unhelpful germs to multiply. This can occur when the sulphur producing bacteria that live at the back of the mouth, tongue, and pockets within the gums multiply. This sulphur can be carried on the breath making it smell unpleasant.

Many people are not aware that their breath smells until they are alerted by others – which usually makes for an awkward and, at times, embarrassing situation. But it can also inspire action to address the problem.

There have been a wide variety of treatments for bad breath over the centuries. Chewing parsley or mint after a meal, apple cider vinegar mouth wash and eating yoghurt, to name a few. However, to know what treatment to use will require some detective work. There are numerous causes of bad breath, also known as halitosis. It is only when you know the cause of the condition that it be treated effectively.

Possible causes of halitosis

Dry mouth (Xerostomia). For reasons yet to be determined, some people living with diabetes are unable to produce enough saliva. Numerous medicines can also contribute to this problem, including medicines for high blood pressure, depression, and bladder control problems. Alcohol and stress can also be contributors. The symptoms of a dry mouth include a rough, dry tongue, a lack of moisture in the mouth, frequent pain in the mouth, cracked and chapped lips, sores and infections in the mouth, and difficulty with swallowing, talking or chewing.

Saliva has a great many roles. It stabilises the ecosystem within our mouth and it helps protect our teeth and gums. It does this by carrying food and bacteria away and by assisting with the repair of early-stage tooth decay. For some, sufficient saliva may be aided by changing medications, keeping hydrated, breathing in through the nose and managing blood glucose levels within a healthy range.

Foods and tobacco products. Garlic, onion and tobacco products can affect our breath which some people find offensive. Tobacco products like cigars, cigarettes and smokeless tobacco can also cause bad breath when it contributes to gum disease and mouth cancer. Gum disease is a problem that can result in tooth loss. Gum disease is a silent, painless condition; as to why it causes no pain is a mystery. It is one reason why the problem is only discovered when teeth feel loose or at a dental check. Our teeth require strong bones to hold them in place. Gum disease causes bone loss when your body responds to bacteria living on and around the teeth. Active gum disease has also been linked to difficulties managing healthy blood glucose levels.

Poor oral hygiene. The bacteria of the mouth feeds on the food eaten. When this food is not removed, halitosis can occur. Brushing and flossing daily will help to remove the daily build-up of bacteria in plaque from the teeth. Brushing the tongue will also help to remove odour-causing bacteria. It is recommended to brush twice a day and floss once a day. Dentures that are not cleaned well may harbour bacteria, fungi and food that can all contribute to bad breath. A dentist visit at least yearly will help identify and treat gum disease. Only a dentist can remove the decaying-causing plaque under the gum line.   

Health problems. Bad breath may be a symptom of another health condition. A doctor will be able to determine this. For instance, a respiratory infection of the nose, throat, windpipe or lungs could be the cause of bad breath. Or a chronic infection in the sinuses causing a post nasal drip. Less common would be an acid and bile reflux from the stomach, kidney problems, various carcinomas, metabolic dysfunctions, and biochemical disorders.

Possible symptoms of halitosis

• Others turning away from your conversation
• Bad breath in the morning that persists
• White film over the tongue
• Dry mouth
• Feeling unwell, tired, persistently high blood glucose levels
• Thickening around the base of the teeth
• Signs of an infection with a post-nasal drip, or thick mucous
• Morning bad breath and a burning tongue
• A constant sour, bitter, metallic taste

Treatment of halitosis

There are some things that you can do to help prevent bad breath:

• See your dentist and doctor to diagnose the cause of bad breath and for a treatment plan.
• Make healthy food choices to support the helpful germs in your mouth. Visit the NDSS website for additional helpful tips.
• Keep hydrated to support saliva production. Discuss with your dentist if chewing gum would help.
• Discuss with your health care team if your medications could be contributing to a dry mouth. Your doctor can arrange a pharmacy home review if you are eligible. 
• Maintain blood glucose levels within a healthy target range to support your immune system.
• Make brushing the teeth and tongue twice daily and flossing daily a part of your daily routine. The germs in the mouth work tirelessly processing the food left in your mouth. Good hygiene will help keep the ecosystem in the mouth balanced in your favour. More on dental health here.
• Remove dentures daily to clean and assess.
• QUIT smoking to reduce the risk of gum disease. Call QUITline on 13 7848 or the NDSS helpline 1800 637 700.
• Consult with family and close friends as to whether your bad breath has resolved.

Halitosis could be caused by many different things. Which is why it may be necessary to have a team approach. So, if someone says to you that your breath smells, perhaps of rotten egg, it is time to put your detective cap on. Good oral health will also help you better manage your diabetes.

By Amanda Callaghan, Credentialled Diabetes Educator, Registered Nurse and Midwife